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Implementing and evaluating care and support planning: a qualitative study of health professionals’ experiences in public polyclinics in Singapore

BACKGROUND: Two polyclinics in Singapore modified systems and trained health professionals to provide person-centred Care and Support Planning (CSP) for people with diabetes within a clinical trial. We aimed to investigate health professionals’ perspectives on CSP to inform future developments. METH...

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Autores principales: Entwistle, Vikki A., McCann, Sharon, Loh, Victor Weng Keong, Tai, E Shyong, Tan, Wee Hian, Yew, Tong Wei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10585850/
https://www.ncbi.nlm.nih.gov/pubmed/37858052
http://dx.doi.org/10.1186/s12875-023-02168-5
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author Entwistle, Vikki A.
McCann, Sharon
Loh, Victor Weng Keong
Tai, E Shyong
Tan, Wee Hian
Yew, Tong Wei
author_facet Entwistle, Vikki A.
McCann, Sharon
Loh, Victor Weng Keong
Tai, E Shyong
Tan, Wee Hian
Yew, Tong Wei
author_sort Entwistle, Vikki A.
collection PubMed
description BACKGROUND: Two polyclinics in Singapore modified systems and trained health professionals to provide person-centred Care and Support Planning (CSP) for people with diabetes within a clinical trial. We aimed to investigate health professionals’ perspectives on CSP to inform future developments. METHODS: Qualitative research including 23 semi-structured interviews with 13 health professionals and 3 co-ordinators. Interpretive analysis, including considerations of how different understandings, enactments, experiences and evaluative judgements of CSP clustered across health professionals, and potential causal links between them. RESULTS: Both polyclinic teams introduced CSP and sustained it through COVID-19 disruptions. The first examples health professionals gave of CSP ‘going well’ all involved patients who came prepared, motivated and able to modify behaviours to improve their biomedical markers, but health professionals also said that they only occasionally saw such patients in practice. Health professionals’ accounts of how they conducted CSP conversations varied: some interpretations and reported enactments were less clearly aligned with the developers’ person-centred aspirations than others. Health professionals brought different communication skill repertoires to their encounters and responded variably to challenges to CSP that arose from: the linguistic and educational diversity of patients in this polyclinic context; the cultural shift that CSP involved; workload pressures; organisational factors that limited relational and informational continuity of care; and policies promoting biomedical measures as key indicators of healthcare quality. While all participants saw potential in CSP, they differed in the extent to which they recognised relational and experiential benefits of CSP (beyond biomedical benefits), and their recommendations for continuing its use beyond the clinical trial were contingent on several considerations. Our analysis shows how narrower and broader interpretive emphases and initial skill repertoires can interact with situational challenges and respectively constrain or extend health professionals’ ability to refine their skills with experiential learning, reduce or enhance the potential benefits of CSP, and erode or strengthen motivation to use CSP. CONCLUSION: Health professionals’ interpretations of CSP, along with their communication skills, interact in complex ways with other features of healthcare systems and diverse patient-circumstance scenarios. They warrant careful attention in efforts to implement and evaluate person-centred support for people with long-term conditions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-023-02168-5.
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spelling pubmed-105858502023-10-20 Implementing and evaluating care and support planning: a qualitative study of health professionals’ experiences in public polyclinics in Singapore Entwistle, Vikki A. McCann, Sharon Loh, Victor Weng Keong Tai, E Shyong Tan, Wee Hian Yew, Tong Wei BMC Prim Care Research BACKGROUND: Two polyclinics in Singapore modified systems and trained health professionals to provide person-centred Care and Support Planning (CSP) for people with diabetes within a clinical trial. We aimed to investigate health professionals’ perspectives on CSP to inform future developments. METHODS: Qualitative research including 23 semi-structured interviews with 13 health professionals and 3 co-ordinators. Interpretive analysis, including considerations of how different understandings, enactments, experiences and evaluative judgements of CSP clustered across health professionals, and potential causal links between them. RESULTS: Both polyclinic teams introduced CSP and sustained it through COVID-19 disruptions. The first examples health professionals gave of CSP ‘going well’ all involved patients who came prepared, motivated and able to modify behaviours to improve their biomedical markers, but health professionals also said that they only occasionally saw such patients in practice. Health professionals’ accounts of how they conducted CSP conversations varied: some interpretations and reported enactments were less clearly aligned with the developers’ person-centred aspirations than others. Health professionals brought different communication skill repertoires to their encounters and responded variably to challenges to CSP that arose from: the linguistic and educational diversity of patients in this polyclinic context; the cultural shift that CSP involved; workload pressures; organisational factors that limited relational and informational continuity of care; and policies promoting biomedical measures as key indicators of healthcare quality. While all participants saw potential in CSP, they differed in the extent to which they recognised relational and experiential benefits of CSP (beyond biomedical benefits), and their recommendations for continuing its use beyond the clinical trial were contingent on several considerations. Our analysis shows how narrower and broader interpretive emphases and initial skill repertoires can interact with situational challenges and respectively constrain or extend health professionals’ ability to refine their skills with experiential learning, reduce or enhance the potential benefits of CSP, and erode or strengthen motivation to use CSP. CONCLUSION: Health professionals’ interpretations of CSP, along with their communication skills, interact in complex ways with other features of healthcare systems and diverse patient-circumstance scenarios. They warrant careful attention in efforts to implement and evaluate person-centred support for people with long-term conditions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-023-02168-5. BioMed Central 2023-10-19 /pmc/articles/PMC10585850/ /pubmed/37858052 http://dx.doi.org/10.1186/s12875-023-02168-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Entwistle, Vikki A.
McCann, Sharon
Loh, Victor Weng Keong
Tai, E Shyong
Tan, Wee Hian
Yew, Tong Wei
Implementing and evaluating care and support planning: a qualitative study of health professionals’ experiences in public polyclinics in Singapore
title Implementing and evaluating care and support planning: a qualitative study of health professionals’ experiences in public polyclinics in Singapore
title_full Implementing and evaluating care and support planning: a qualitative study of health professionals’ experiences in public polyclinics in Singapore
title_fullStr Implementing and evaluating care and support planning: a qualitative study of health professionals’ experiences in public polyclinics in Singapore
title_full_unstemmed Implementing and evaluating care and support planning: a qualitative study of health professionals’ experiences in public polyclinics in Singapore
title_short Implementing and evaluating care and support planning: a qualitative study of health professionals’ experiences in public polyclinics in Singapore
title_sort implementing and evaluating care and support planning: a qualitative study of health professionals’ experiences in public polyclinics in singapore
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10585850/
https://www.ncbi.nlm.nih.gov/pubmed/37858052
http://dx.doi.org/10.1186/s12875-023-02168-5
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